The Biden administration is expected to announce Tuesday stepped-up enforcement of so-called mental health parity laws requiring health insurers to cover mental illness on the same basis as medical and surgical needs, the most aggressive intervention yet by the federal government.
Federal regulators missed a December deadline for a highly anticipated report, but Labor Secretary Marty Walsh, whose department oversees insurance plans covering 137 million Americans, has made his priorities clear. “We’re enforcing parity for mental health and substance use treatment. We all know what that is in our communities,” he said Friday in a speech to the U.S. Conference of Mayors’ winter meeting.
The first parity law passed in 1996 at a time of high medical inflation that led to cost-cutting and especially affected mental health. It requires health insurance plans that include mental health treatment to ensure that they pay for those services in ways that are comparable to what they provide for medical and surgical treatment. The law was broadened in 2008 to include addiction services.
Despite the law, neither the federal government nor the states did much to enforce it, especially for practices that are hard to measure, like determinations of “medically necessary” treatment and whether an insurer contracts with sufficient numbers of mental health providers in insurance networks to meet members’ needs.
A research report by Milliman, a health care consultancy, found that patients went out of network for behavioral health treatment more than five times as often as they did for medical and surgical care in 2017. Patients usually do that when they can’t find an in-network provider. Insurers generally pay far less for out-of-network providers, and that leaves patients to pay more.
Congress finally gave health plans and regulators from the Department of Labor and the Department of Health and Human Service detailed guidelines for measuring compliance with parity rules a year ago, along with the power to conduct exhaustive audits to measure compliance. Regulators are now authorized to require that insurers show in an analysis that they are, in fact, providing comparable coverage.
Audits typically take well over a year of back-and-forth requests from regulators and responses from insurers. If the audits eventually determine that a carrier is out of compliance, that carrier is required to notify every subscriber that it has violated federal law – a sort of shaming that advocates believe will act as a deterrent.
Former Rep. Patrick Kennedy, who authored the parity legislation in the House 14 years ago, said the Labor Department was now poised to bring the toughest enforcement actions ever against out-of-compliance insurers. (Note: Kennedy is a member of the MindSite News Editorial Advisory Board.)
Walsh, who has spoken publicly about his long-term recovery from alcohol addiction, has a staff of “fire-breathing, passionate people for parity that have never had an outlet.” Now, Kennedy said, “they’re going gangbusters.”